FLEXIBLE FITNESS: Numbness and tingling waking you up at night? Could be carpal tunnel syndrome

By Michelle Cormier/Daily News Correspondent

Tuesday

Dec 19, 2017 at 2:33 PMDec 19, 2017 at 2:33 PM

Do you ever wake up in the middle of the night with numbness and tingling in your hands? Or maybe you feel clumsy and are dropping items such as a glass. If so, you may have symptoms of carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is a common problem caused by pressure on a nerve (called the “median” nerve) as it enters your hand. The carpal tunnel is a narrow rigid passageway at the bottom of your hand and has several structures that pass through it. The floor of the tunnel is made up of small bones called carpal bones in the back of your hand. The roof of the tunnel is made up of a transverse carpal ligament which attaches to two bones in the wrist. There are 9 tendons along with a nerve called the median nerve that pass through this tunnel. The tendons allow you to bend and straighten your fingers and the median nerve provides sensation to your fingers and controls the muscles at the base of your thumb that are used to grip items.

CTS is caused by compression of the median nerve at the wrist. Anything that narrows the space of the tunnel can cause the symptoms. Tendons are surrounded by a sheath and inside there is fluid (called “synovium”) that allows the tendons to glide as the hand opens and closes. The synovium can become thick due to repetitive hand motions that can put pressure on the nerve. A broken wrist or arthritis can change the floor of the tunnel by causing one of the carpal bones to protrude into the tunnel and put pressure on the median nerve. Fluid retention can also put pressure on the nerve. This occurs most often during pregnancy and usually subsides after delivery. Some other risk factors include diabetes and obesity.

Women are three times more likely than men to develop CTS, likely due to having smaller hands than men and therefore have a smaller carpal tunnel. The dominant hand is most likely affected and CTS occurs only in adults (usually between the ages of 30-50). Although it can affect employees who do data entry on a computer, assembly line workers are three times more likely to be diagnosed with it. Use of vibrating tools, keeping the hands in the same position, or moving them in repetitive ways increases the likelihood of developing CTS.

Symptoms of CTS start gradually with occasional numbness and tingling on the palm side of the thumb, Index, middle and ring fingers. This often occurs at night due to prolonged periods of the wrist being in a bent position when sleeping. The sensation may feel like pins and needles and may cause you to want to shake your hands to get rid of the sensation. You may experience these sensations when holding items such as the phone or a book, or when driving. Numbness can become constant over time and pain may increase as well. As CTS progresses, it starts to weaken the muscles at the base of the thumb, causing you to feel like you don’t have a good grip on an object even dropping items. In severe cases of CTS there is constant numbness and a significant lack of pinch strength.

CTS is diagnosed first with a medical history of your symptoms, such as when they began and when they occur. A physician may try to reproduce the symptoms by tapping over the course of the median nerve from the forearm into the wrist on the palm side of the hand. This is called a Tinel’s test. Bending your wrist down towards your palm may also increase the pins and needles sensation. X-ray can rule out arthritis or a broken bone but does not confirm the diagnosis of CTS. Electromyography testing (EMG) which records the electrical activity of muscles can confirm a diagnosis of CTS.

How can you treat, or better yet prevent, CTS? Limiting forceful gripping, taking breaks at work or during leisure activities, reducing the speed at which you do a repetitive motion, adjusting your keyboard to elbow height or slightly lower, maintaining good posture, and stopping activities that might be causing symptoms can be effective in helping to prevent CTS. Once the symptoms are present, consult your primary care doctor. Your physician may recommend n may recommend wearing a splint at night. Flexing the wrist down towards the palm or extending the wrist up increases the symptoms of CTS because these positions narrow the tunnel. Wearing a splint with the wrist straight or in a neutral position may help to reduce pressure on the nerve.

If symptoms persist, your physician may recommend Occupational Therapy or seeing a physician that specializes in hand injuries. It is important not to ignore your symptoms of CTS as your grip strength can become weaker affecting your ability to pinch and hold on to items if CTS is not addressed.